Contract Details
Ancillary Care Services
Facility name
Cardiosom
Provider ID
P000005745
NPI
1972597201
Tax ID
111373362
Effective Date
4/1/2012
Last Updated
10/16/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
206 North Fraser Street
Georgetown, SC 29440
United States
County
Georgetown
Phone
8435273600 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address